Incoherent DoH thinking undermines care

Prime minister Gordon Brown tells us that the NHS is rightly 'recognised by everyone as a force for good in our country'.

Imagine how much stronger that force would be if the government ever exhibited a coherent approach to policy making.

Mr Brown's remarks came at the launch of the screening plans for England which are intended to reduce levels of heart disease, chronic kidney disease (CKD), diabetes and stroke. Under the plan, patients will have the right to diagnostic tests at their GP surgeries as part of efforts to increase the NHS's focus on prevention.

But surely no one could have a complaint about such a worthy plan?

Well, perhaps they wouldn't if the DoH had not rejected proposals to increase the quality indicators for many of the same disease areas just a couple of weeks ago.

GPC proposals for a redistribution of points in the quality framework included new indicators for patients with heart failure, CKD and peripheral vascular disease (PVD) intended to address the very areas the prime minister is concerned about, with the added advantages that the new targets would apply to the whole of the UK.

Instead, the DoH decided that quality points should be redistributed towards targets for extended surgery hours. This is despite the DoH's own research showing that the vast majority of patients are happy with existing opening times.

In fact, the extended hours obsession apparently gripping the whole of Whitehall is extremely small beer in the eyes of those who live in the real world - certainly compared with cardiovascular disease.

Extended opening is an urban issue, for middle-class commuters and especially it would seem for the south of England. The DoH's proposals give no consideration to rural areas or those with poor evening transport links or the fact that it is not even an issue in some parts of the UK, yet it offers a one-size-fits-all plan.

It is also a plan that goes against the original ideals of the quality framework; that it used evidence-based indicators to improve the health outcomes of patients.

Instead the DoH seems to think it can use it to tinker with any aspect of practice it sees fit. There is no evidence to show that evening opening improves health outcomes - but there is for the treatment of heart failure and PVD.

It is hard to believe that politicians really believe that a headline-grabbing policy that plays well to the business community and those who rarely use primary care is worth compromising on the care of people with actual diseases. But that appears to be the outcome of incoherent policy making in this case.

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